Simultaneous computed tomographic angiography of the coronary and radial arteries.

Our aim was to assess a method of simultaneous computed tomographic (CT) angiography of the coronary and radial arteries without increasing contrast medium usage. Radial access is a standard approach in coronary interventions. However, radial artery puncture is difficult due to the small size of the radial artery and potential unexpected anomaly. If we can obtain anatomical information on the radial artery beforehand, the success rate of radial artery puncture may increase. Simultaneous CT angiography of the coronary and radial arteries without increasing contrast medium usage was planned. Contrast medium was injected in the right elbow vein. Time to peak concentration of contrast medium in the aorta (TPA) and time to peak concentration of contrast medium in the radial artery (TPR) were obtained by the test scan in each patient based on the time-density curve. The main scan was performed using 265 mg iodine/kg of contrast medium. The start time was decided according to TPA and TPR, respectively. This study included 192 cases [age, mean ± standard deviation (SD),72.0 ± 9.9 years]. Mean TPA and TPR were 19.0 ± 2.3(SD) seconds and 34.0 ± 10.0 s, respectively. Clear images of radial arteries were obtained in 89.6% (right) and 84.9% (left). Radiation exposure during cardiac CT angiography (CCTA) and radial artery CT angiography (RCTA) was 269.9 ± 155.6 mGy cm and 31.1 ± 12.3 mGy cm as dose length product, respectively. RCTA immediately following CCTA was safely performed with minimal increase in radiation exposure and no additional contrast medium. These images can help in radial access as well as distal radial access in coronary interventions.

A Prospective Multicenter Study Using a Virtual 3 Fr Percutaneous Coronary Intervention System: The V3 Registry.

OBJECTIVES: To evaluate the safety and feasibility of virtual 3 Fr (V3), sheathless 5 Fr percutaneous coronary intervention (PCI). BACKGROUND: A small-diameter guiding catheter (GC) makes less-invasive PCI possible. The V3 is an extremely slender PCI system; however, the outcome of using this system has not yet been determined. METHODS: The V3 registry is a prospective, multicenter, non-randomized study that enrolled patients who underwent elective V3-PCI. The primary endpoint was clinical success rate, and the secondary endpoints were PCI success rate in all cases, major adverse cardiac and cerebrovascular event (MACCE) at 30 days, and access-site complications. RESULTS: A total of 260 patients with 321 lesions were enrolled. Of this group, 70% were male and the mean age was 70.8 ± 10.0 years. Type B2/C lesions comprised 50.7% of the total. The clinical success rate was 95.8%, and the PCI success rate was 99.2%. PCI failure was reported in 2 chronic total occlusion cases. No MACCE was reported. Although there was no major bleeding, hematoma occurred at the puncture site in 12.7% of cases. There was a single radial artery occlusion (0.4%) without symptoms. CONCLUSIONS: PCI with the V3 was safe and feasible. Radial artery occlusion and major bleeding complications were extremely low. However, access-site hematoma frequently complicated catheter exchange.